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  1. 1. Continua Health Alliance: Advancing Information Technology in the Personal Health Solutions Ecosystem By Chuck Parker, Executive Director, Continua Health Alliance Conflict of Interest Disclosure Chuck Parker, Executive Director, Continua Health Alliance Has no real or apparent conflicts of interest to report.
  2. 2. Technology Out Paces Biology Our evolutionary ability to store fat cannot support our current sedentary high-calorie activities Private and Confidential, Oregon Medical Laboratories 3 Remote Patient Monitoring Objectives: • What is Continua? • Market influence and implementation • Use case driven • Interoperability – Approach – Constraining – Protocol • Market and political drive 2/24/2010 4
  3. 3. The Continua Health Alliance Mission 2/24/2010 5 Connected Healthcare Monitoring Market • The challenge: – In England 15.4 million people, including 60 percent of those over age 60, suffer from a long-term condition. LTCs account for 72 percent of all inpatient bed days, 65 percent of all outpatient appointments and 52 percent of all GP appointments. LTCs consume 69 percent of England’s primary and acute care budget (NHS England) – Almost half of all Americans – 133 million people in 2005 – have at least one chronic condition, and the medical care costs of people with chronic diseases consumes more than 75 percent of US medical care costs (CDC) – Up to 60% of all medication prescribed is taken incorrectly, or not at all (National Council on Patient Information & Education) Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce. Last Updated: January 6, 2008 6
  4. 4. Need for Transformation • Area of connected health/home health monitoring is predicted to grow from a $3B market in 2009 in North America and Europe to an estimated $7.7B in 2012 (Data Monitor, 2007) • Number of connected health subscribers worldwide will increase to 55.5 million by 2016, representing a forecast CAGR of almost 72%, (InMedica, 2008) • There is increasing evidence to support the value of remote monitoring for patients with chronic diseases, including: – 35-56% reduction in mortality; – 47% reduction in risk of hospitalization; – 6 days reduction in length of hospital admission and – 65% reduction in office visits; – 40-64% reduction in physician time for checks and – 63% reduction in transport costs (Cleland et al 2005; Lee R, Goldberg et al, 2003; Scalvini S et al., 2001; Elsner et al, 2006; Van Ginneken et al 2006) 2/24/2010 7 Realize Peak Health Potential • Goal – Experience peak health potential throughout life for a high quality of life at minimal costs • Reality – Average individual is experiencing much less of full health potential than expected at a high financial & quality of life cost • Cause – Adverse health events such as stress, poor nutrition, inactivity… are causing the population to fall away from their peak health potential Time Peak Health Potential Line Min Max Unpredictable Health Event/Accident Expectations Health Costs Poor nutrition, Actual Health inactivity, Experience Stress… Non-modifiable & Unpredictable Health Max Min Modifiable & Predictable Health Adapted from Oregon Medical Labs Death 8
  5. 5. Address 60-80% modifiable Adverse Health 91% Diabetes 83% Heart Disease • Many diseases can be broken down into non-modifiable and modifiable contributors 69% Cancer • Non-modifiable contributors – Age, gender and genes • Modifiable contributors – Lifestyle choices Actual Goal • Today, poor lifestyle choices increasingly are the largest Non-modifiable Contributors to Disease contributors to common Modifiable Contributors to Disease adverse health outcomes Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001 Sep 13;345(11):790-7. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22 9 Remote Patient Monitoring: enablers & drivers 2/24/2010 10
  6. 6. Remote Patient Monitoring Objectives: • What is Continua? • Market influence and implementation • Use case driven • Interoperability – Approach – Constraining – Protocol • Market and political drive 2/24/2010 11 Remote Patient Monitoring: Standards • Continua founded to organize and push market in one direction • Structure (Working groups) is to model real-world Use Cases from industry and healthcare • Process then deconstructs requirements and selects best industry standards • Then vet processes and fill holes either with direct work within SDO’s or add definitions and refinements • Ballot and then publish program and guidelines • Strongest Value of Continua though is the Certification program for interoperability of devices 2/24/2010 12
  7. 7. Guidelines → Certification → Recognizable Logo 2/24/2010 13 Ecosystem Development Developer Resources Certification Web-based environment Test and certification tools (repository, collaboration tools) Right to use certified logo upon Reference source code completion of successful PlugFests certification Market Intelligence Safe Environment Access to market research data Industry competitors could discuss without Anti-trust Access to pre-publication drafts of the design guidelines Unified Political drive to encourage adoption Internal and external education Single voice for industry and training Wednesday, February 24, 2010
  8. 8. Remote Patient Monitoring Objectives: • What is Continua? • Market influence and implementation • Use case driven • Interoperability – Approach – Constraining – Protocol • Market and political drive 2/24/2010 15 Continua Domains • Continua segmented the market in three large Domains: Aging Independently • An adult child helping their elderly parents age gracefully in their own home. • Basic life monitoring as appropriate (ADL) Health & Wellness Disease Management • Weight loss • Vital sign monitoring • Fitness (RPM) • Email / chat / video • Medication reminders and • Appt scheduling compliance • Personal Health Records • Trend analysis and alerts • Connect with family care givers 2/24/2010 16
  9. 9. Domain 1: Continua Use Cases • Disease management market: – evolve the current models of care; chronic and post-acute – connect patients, families and healthcare providers to the right information at the right time – more informed decision-making – empowering people to take a more active role in their own care – e.g.: Northern Ireland, West Lothian (UK); AOK Cardio Integral (DE) – mostly led by public healthcare administrations; statutory health insurers 2/24/2010 17 Domain 2: Continua Use Cases • Health and wellness market: – health conscious and worried well – fitness and lifestyle trackers, PHRs – employer programs and occupational health (HRA) – national public health programs, screening – e.g.: Diabetes Prevention DEHKO (FI); metabolic syndrome – mandatory HRA (JP); 10K Steps a Day; Nike Plus; Google Health; MS HealthVault; Dossia – mostly privately driven; a few national programs 2/24/2010 18
  10. 10. Domain 3: Continua Use Cases • Ageing independently market: – residential care, independent living facilities, individual homes – support ADL, fall detectors, bed occupancy, medical reminders, … – personal emergency response services – e.g.: Tunstall, Philips Lifeline, GE Quiet Care – driven by a mix of social care providers, group housing, individual subscribers 2/24/2010 19 V 1 Interoperability Standards - Protocol Pulse Oximeter • 11073-10404 = Pulse Oximeter PC • 11073-10406 = Pulse / Heart Rate Pulse / • 11073-10407 = Blood Pressure Blood Pressure • 11073-10408 = Thermometer • 11073-10415 = Weighing Scale Personal Weight • 11073-10417 = Glucose Health System • 11073-10441 = Cardiovascular Fitness Monitor Scale • 11073-10442 = Strength Fitness Equipment • 11073-10471 = Independent Living Activity Glucose • 11073-10472 = Medication Monitor Cell Phone Meter Cardiovascular and Strength Fitness Monitor Bluetooth Medical Device Profile Specification Independent Set Top Box Living Activity Medication Monitor USB Personal Healthcare Aggregator Device Class Specification 2/24/2010 20
  11. 11. V 1 Data Standards - Syntactical Healthcare Provider CDA/CCD-based Disease Personal Health Monitor (PHM) Labs Management Specification Service Home-based Remote Patient Monitoring (RPM) System Electronic Health Record System XDR Transport Specification Patient Vital Sign EHR / PHR Devices Use Case Development M1: Decompose UC M2: Select Standards M3: Identify gaps between into requirements standards and requirements 2010) inter 2010) V2 (W N pring g for HR ring V1.5 (S nitor l Codin Monito ti on Mo Clinica ation Medica ice • nd Respir vanced ng Dev WAN ECG a ice • Exit Ad Monito ri n the Exit • ExitMonitoring Dev Pea k Flow ation o Device ity • He lt h Inform ce Successful TWG a l Activ TWG, oUCWG Area Successfulareview rfa Upload Inte Physic we r B dy • t xHR e • ow-Popresentation (E2E eaker-NeTWG, or Devic Sn Arch, p Monit Ballot, BOD • Ultra-L rk • Pum approval Netwo AN UCWG)lin m V 1 Insu o we r L HR • fro Low-P g for x city Errata dio • l Codin thenti • wer Ra Clinica ent Au Low Po • and Pati Sharin g • D evice ation sers • d Inform iple U M5: Create Test Co ntrolle e nt Mult • a nagem M4: Develop Procedures and complete • Disease M Guidelines review M6: Update Test Tool Exit Exit TWG review Successful Exit and ballot TCWG review Pass Tool 22 Test
  12. 12. V2 Use Cases Underway PAN Device Health Electric Health Record (XHR) Interface Application WAN Device Record Physical Activity Monitor Hosting Device Device (PAN) Device Interface Medication Monitor Service (WAN) Interface Electrocardiogram (ECG) Insulin Pump LAN Device Low Power Radio Network (LAN) Interface Portable XHR Media Extension V1 Extensions (e.g., Multiple device users, enhanced device Final link in end-end connectivity authentication) 23 Remote Patient Monitoring Objectives: • What is Continua? • Market influence and implementation • Use case driven • Interoperability – Approach – Constraining – Protocol • Market and political drive 2/24/2010 24
  13. 13. Working Group Structure - Internal Board Of Directors More than 2,000 members Participating in the various Working Groups Executive Director VTM Admin Test & Wellness Policy Use Case Technical Marketing Regulatory Certification Solutions Strategy WG WG WG WG WG WG WG Expert Testing Latin PR & EU Japan U.S. Australia Group Sub- and America Marketing Policy Policy Policy Policy NHS, AAFP, Committees Certification Policy agency WG WG WG WG ATA, AHA… Lab WG 2/24/2010 25 V1 Interoperability - Semantic • Use of HL7 and SNOMED CT for semantic understanding • V 2 will have further implementation and conditional understanding 2/24/2010 26
  14. 14. Interoperability in Three-tier Approach • Continua constrains the outputs at the device level. (PAN interface) – Reduces device overhead and intelligence requirements – Reduces power requirements – Reduces development time – Reduces connection complexity • Intelligence is at the Hub / Manager – Understands what it is communicating with – What data to expect – May issue commands to send certain data 2/24/2010 27 Continua Reference Device Classes Application Hosting Device PAN “Adapter” Device: to represent a device as a PAN PAN Device in the Device Continua ecosystem LAN “Sharing” Device: to represent a device as a LAN LAN Device in the Device Continua Ecosystem WAN Health Record Device Device 28
  15. 15. V1 Certification Process SDO Transport Continua Continua Certificate Compliance Certification Testing & Logo Test Test Plans Report Members TCWG Test Lab Test Test Admin Suites Logo Remote Patient Monitoring Objectives: • What is Continua? • Market influence and implementation • Use case driven • Interoperability – Approach – Constraining – Protocol • Market and political drive 2/24/2010 30
  16. 16. Working Group Structure - External Board Of Directors More than 2,000 members Participating in the various Working Groups Executive Director VTM Admin Test & Wellness Policy Use Case Technical Marketing Regulatory Certification Solutions Strategy WG WG WG WG WG WG WG Expert Testing Latin PR & EU Japan U.S. Australia Group Sub- and America Marketing Policy Policy Policy Policy NHS, AAFP, Committees Certification Policy agency WG WG WG WG ATA, AHA… Lab WG 2/24/2010 31 RPM market in the future • Personal Connected Health • The individual / home as the hub • Convergence consumer / healthcare • Mobile health / Personal Health Records fitness - sometimes with public incentives • Rewards for keeping people healthy • Greater integration among wellness, health and social care • Best-of-breed plug and play • Increased connectivity, evolutionary, scalable, service driven offerings 2/24/2010 32
  17. 17. Health App Growth iTunes Parks Associates- All Rights Reserved End-to-end demo – Vancouver Q2 2009 Device Interface XHR Interface Device Manager WAN Sender Receiver Based upon proposed PHR protocols for Continua WAN EHR Glucose Meter Roche Accu-Chek 360 xHR IP network Web services Wi-fi or 3G Disease management Pulse Oximeter platform LNI Android-based G1 Cell phone 20601 manager
  18. 18. RPM market now: Current Participants • Continua membership shows across the board interest both from supply and demand sides: – Medical devices – Governmental Agencies – Fitness – Pharma – Health care providers – Health insurers – Telecommunications – IT – Integrators – Applications (PHR, EHR, desktop) 2/24/2010 35 Promoter Members Open International
  19. 19. Contributor Members 7 Layers AG Centre for Global eHealth GenerationOne, Inc. 24eight, LLC Advanced Digital Institute Innovation Cerner Corporation GlaxoSmithKline Google Inc. More Than Air Products Chiptech Limited Hill-Rom Hitachi, Ltd. 228 Member Alcatel Lucent Alere Christus Health Chunghwa Telecom Co., Ltd. Holst Centre (IMEC) Companies! Allion Test Labs, Inc. ConnectBlue AB Home For Life Solutions All Medicus Co., Ltd. Continuity Health HoMedics American Heart Association Convergence Wireless, Inc. Honeywell HomMed LLC Analog Devices CSR plc Hosiden Corporation Analogic Corporation CYPAK AB Hospira, Inc. Andago Ingenieria s.l. Dell HTC AppsHub, Inc. DELTA I2BC – Insitute of Innovation for Human ASE Consulting Limited Denso Corporation Wellbeing AstraZeneca Dossia Consortium iFoundry Systems Singapore Pte Ltd AT4 Wireless Duodecim Medical Publications iMetrikus AT&T Mobility Dynastream Innovations Inc. Industrial Technology Research Institute Attrezzature Medico Sanitarie SRL eflow Inc. Infineon Technologies Authentidate Holding Corp. Elbrys Networks INFORSON Co., Ltd. AViTA Ember Corporation Innomed Medical Zrt. Awarepoint Empirica GmbH Innovation Centre Scotland BiancaMed Ericsson Nikola Tesla d.d. Institute for Infocomm Research Biocomfort Diagnostics GmbH ETRI Institute of Biomedical BIOSPACE Co., Ltd. EuroTech, Inc. Insung Information Co., Ltd. Bluegiga Technologies Oy Fairbanks Scales InterComponentWare, Inc. Boston Scientific FitLinxx Intramed A/S Broadcom Corporation Flextronics Design SRL Kai Sensors, Inc. Brunel University France Telecom R&D, LLC KDDI BXI Health Systems, LLC Freescale Semiconductor Korea Electronics Technology Institute Cambridge Consultants Ltd. frog design, inc. Laird Technologies Canada Health Infoway Frontline Test Equipment Lamprey Networks, Inc. Cardiff University Fujitsu Limited LAXTHA Inc. CEA - LETI Contributor Members Continued LG Electronics Inc. • Product Development Tekoa Technologies Inc. Lifescan Technologies (PDT) Telbios, SpA LifeWatch AG • Proskauer Rose LLP Telecom Italia SpA Logic • Proximiti Communications, Inc. Telefonica S.A. Marvell International Ltd. • Red Embedded Design Telehealth Solutions Ltd. McLaren Applied Technologies • Renesas Technology America TELUS Health Solutions MedApps, Inc. • ResMed Corp. Textronics Inc. Medgate AG • RF Technologies Toshiba Home Appliances Corporation MedHelp International • RMD Networks Toumaz Technology Limited Medixine Oy • RTEmd TSB Microlife Corporation • Ryoyo Electro Corporation TTA MindTree Limited • Sagemcom Tyco Electronics Motorola • Sensor Technology & Devices Ltd Tynetec Ltd MIR- Medical International Research • Shimmer Research UnitedHealth Group MTI Ltd. • SHL Telemedicine University of Applied Sciences MTS Medication Technologies • Shorewood Packaging Technikum Wien Murata Manufacturing Co., Ltd. • Sigma Designs University of Miami - Miller School of • Silicon and Software Systems Medicine NEC Access Technica, Ltd • Silicon Laboratories, Inc. Valentia Technologies Nestle • SK Telecom Americas Verizon Neusoft Medical Systems • Smartlife Technology Ltd VigNet Inc. Nippon Telegraph and Telephone Corporation • Sony Electronics Inc. Vitaphone GmbH Nordic Semiconductor ASA • SterlingTech, Inc. VivoMetrics, Inc. North End Technologies • Stollmann E+V GmbH Vocollect Healthcare Systems, Inc. Novo Nordisk • STMicroelectronics N.V. Vodafone Group Services Ltd. Nuubo (Smart Solutions Tech) • Sumitomo Electric Networks, Inc. VTT Technical Research Centre of Finland ON Semiconductor • Sybase iAnywhere Waldo Networks Oregon Medical Labs • T-Mobile USA Welch Allyn Oregon Scientific Inc. • TaiDoc Technology Corporation Wind River Orthosensor, Inc. • Taiyo Yuden Co., Ltd. Wipro Technologies PA Consulting Group • Tanita Corporation Yellow Digital Health Lab Pfizer • TechnoGym Zarlink Semiconductor Polymap Wireless ZeroG Wireless, Inc. Precor Fitness Ziehm Medical LLC ZyXEL Communications, Inc. 38
  20. 20. Industry Liaisons 39 Thank you! ThankChuck Parker You Executive Director admin@continuaalliance.org www.continuaalliance.org 40
  21. 21. Remote Patient Monitoring • Additional Content 2/24/2010 41 RPM Market: the Market Segments Multiple providers / service oriented Wellness Biometrics Management/Support Device / Testing Systems Systems / Sensors Glucose Meter Weight Scale Bio-metric/ Weight Behavioral Cholesterol Spirometer Blood-Presser Responses HDL/LDL HRA/Health Administrative Cuff Triglycerides Blood- Assistant Fitness, Pressure nutrition, stress Blood management… Sugar Person Fitness Lung Air Pulse Centered Volume Equipment Healthcare provider Oximeter Wellness Resting Body Fat Center Disease Heart Rate % Gait management Pedometer analysis Body Fat service Information Analyzer Systems Medication Activity Tracking Hub PHR/PHA Family Classes Elderly care monitoring givers services 2/24/2010 42
  22. 22. Remote Patient Monitoring • Additional Technical Content 2/24/2010 43 Continua E2E Reference Topology Embedded Apps Could subsume PAN interface and expose WAN interface Health PAN Device Application WAN Device Record PAN-Interface Hosting Device Device xHRN-Interface WAN-Interface LAN Device LAN-Interface
  23. 23. PAN Interface IEEE PHD State Machine Disconnected • Agent states Transport disconnect indication Transport connect indication shown, Manager is similar Connected Disassociating Associated assocRelReq +entry / TxAssocRelReq Operating • Configuration state TxAssocAbort RxAssocRelReq/ TxAssocRelRsp RxAssocAbort transmits all static RxAssocRelRsp Unassociated TxAssocAbort data one time for RxAssocAbort Configuring RxConfigEventReportRsp efficiency RxAssocRelReq/ TxAssocRelRsp (accepted-config) Waiting Approval assocReq • Operating state is RxAssocAbort RxAssocRsp Or RxConfigEventReportRsp where TxAssocAbort TxAssocRsp (accepted) (unsupported-config) measurements are Associating (rejected) TxConfigEventReportReq transmitted + entry / TxAssocReq RxAssocRsp Sending Config (accepted-unknown-config) WAN Interface Goals • Minimal Payload Translation – Keep the device readings consistent with PAN (e.g., same nomenclature) • Minimal Payload Transformation – Manager should not be forced to deal with the complexity of transformations from one payload model to another • Support for all 3 Continua Domains – Health and Fitness, Aging Independently, and Disease Management • Extensibility • Minimize divergence of standards
  24. 24. WAN Recommendations • HL7 v2.6 messages using IHE PCD-01 – Initially constrained to IEEE 11073-20601 and 104xx nomenclature for personal health devices – Can be extended to support IEEE 11073–10101 terminologies and core components of the -10201 information model for clinical devices • Web Services transport based on WS-I Basic Profile – Work with HL7, WS-I, and IHE ITI on further Web Service Profiles – TLS for Security • Define placeholder for alarm, alert, control, and command messages but defer message contents for later versions WAN Proposed Protocol Stack Device Intermediary Remote Monitoring Management System 48
  25. 25. Personal Connected Health IMPLANT PULSE OX Health & Wellness BLOOD- • Weight loss PRESSURE CUFF • Fitness Cell Phone • Email / chat / video PEDOMETER Digital • Appt scheduling Home • Personal Health Records Healthy HOME AUTOMATION family & CONTROL PC Disease Management FITNESS EQUIPMENT • Vital sign monitoring (RPM) • Medication reminders and MEDICATION Personal Health System compliance TRACKING • Trend analysis and alerts • Connect with family care Elderly givers Internet Aging Independently • An adult child helping their Personal elderly parents age gracefully Health Weight loss Records Disease in their own home. and fitness Healthcare management • Basic life monitoring as coaching Professionals service appropriate (ADL) Family care givers 2/24/2010 49 Example Application Parks Associates- All Rights Reserved
  26. 26. Example Application Parks Associates- All Rights Reserved Mobility Topics • Interoperability standards (Continua) • Clinician acceptance (workflow, data overload) • Policy (reimbursement, regulatory) • Liability (indemnity) • Privacy (identifiers) • Security (encryption) • Consistency of cell coverage • Cost • Business models
  27. 27. A Perspective on the Ecosystem Parks Associates- All Rights Reserved